COVID‐associated arthritis after severe and non‐severe COVID‐19: A systematic review

AIM: Since the coronavirus outbreak became a global health emergency in 2020, various immune‐based effects, such as inflammatory arthritis (IA), have been recorded. This study aimed to determine the role of COVID‐19 severity on post‐COVID arthritis. METHODS: We systematically reviewed 95 patients who developed arthritis after severe and non‐severe COVID‐19 infection by searching the databases, including PubMed, SCOPUS, and EMBASE. We used the term “COVID‐associated arthritis” because there was no definite diagnostic method for classifying arthritides after COVID‐19 infection, and the diagnosed arthritis types were based on the authors' viewpoints. RESULTS: After evaluating the data between the two severe and non‐severe COVID‐19‐infected groups of patients, the results showed that the COVID‐19 severity may affect the pattern of joint involvement in IA. In both groups, combination therapy, including oral nonsteroidal anti‐inflammatory drugs with different types of corticosteroids, was the most common treatment. In addition, the mean age and comorbidities rate was higher in the severe COVID‐19 group. Even though the patients in the severe COVID‐19 group developed more serious COVID‐19 symptoms, they experienced milder arthritis with better outcomes and more delayed onsets that required less aggressive therapy. CONCLUSION: We conclude that there may be an inverse relationship between COVID‐19 severity and arthritis severity, possibly due to weaker immunity conditions following immunosuppressant treatments in patients with severe COVID‐19.